Fields marked with * are mandatory.
1. Personal Information
Membership Type
Which constituency would you like to join? You must be using NSFT services or have done within the last three years to become a Service User member. To join the Carers constituency you should be an unpaid carer of an NSFT service user. Anyone using services and their carers can be Public category if preferred.
Member type
Public
Service User or Carer
Title
Unspecified
Mr
Mrs
Miss
Ms
Dr
Professor
Canon
Reverend
Wing Commander
Capt
Col
Major
Commodore
Cllr
Sister
Master
Lady
Mayor
Father
Honourable
Lord
Lt Col
Senior Counsel
Sir
Commander
First name *
Last name *
Date of birth *
DD
MM
YYYY
Gender
Unspecified
Male
Female
Transgender Male
Transgender Female
Other
Please enter your postcode and click Get Address
Address *
Town or City
County
Postcode *
Country
Telephone
Mobile
Email
Email communication helps us reduce costs and is more environmentally friendly. Please only select post if essential.
Preferred method of contact
Email
Post
Ethnic Origin
Not stated
White - English, Welsh, Scottish, Northern Irish, British
White - Irish
White - Gypsy or Irish Traveller
White - Other
Mixed - White and Black Caribbean
Mixed - White and Black African
Mixed - White and Asian
Mixed - Other Mixed
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Other Asian
Black or Black British - African
Black or Black British - Caribbean
Black or Black British - Other Black
Other Ethnic Group - Arab
Other Ethnic Group - Any Other Ethnic Group
Religion/Belief
Not Stated
Christian
Muslim
Hindu
Jewish
Atheist
Other
Prefer not to say
Sexual Orientation
Not Stated
Heterosexual
Gay or Lesbian
Prefer not to say
Bisexual
Other
2. Additional Information
Disabilities
No
Yes
A sensory disability
A physical disability
A learning disability
A mental health problem
Any other special need (please list in the 'Notes' section)
Hearing impairment
Any other special need
Visual impairment
Autism
Prefer not to say
How would you like to be involved?
Interested in finding out more about standing as a governor
Volunteer at the Trust
3. Review
Member type
Last Used Services
Title
First name
Last name
Date of birth
Gender
Address
County
Postcode
Country
UK
Telephone
Mobile
Email
Ethnic Origin
Religion/Belief
Sexual Orientation
Preferred method of contact
Disabilities
How would you like to be involved?
4. Finish
*
I apply to be a member of Norfolk and Suffolk NHS Foundation Trust and be bound by the rules of the organisation. I give consent to the processing of my information.
The data you supply will be used only to contact you about the Trust, membership or other related issues. In accordance with the General Data Protection Regulations (GDPR): Information will be kept secure, treated confidentially and only used for developing the Foundation Trust. Our main trust wide privacy notice, which sets out in full the Trust's lawful reasons for processing personal data and all your rights under GDPR is available to view and download at
www.nsft.nhs.uk
.
In addition to the trust’s guidelines your data will also be subject to the Civica Engagement Solutions GDPR guidelines. Please click
here
for for full details.
Please tick here if you consent to your details being added to the Public Register.